Provider Demographics
NPI:1053440024
Name:DRUCKER, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DRUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 MANCHESTER AVE
Mailing Address - Street 2:STE. 107
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4939
Mailing Address - Country:US
Mailing Address - Phone:760-632-9042
Mailing Address - Fax:760-632-0574
Practice Address - Street 1:4403 MANCHESTER AVE
Practice Address - Street 2:STE. 107
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4939
Practice Address - Country:US
Practice Address - Phone:760-632-9042
Practice Address - Fax:760-632-0574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42102208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88294Medicare UPIN